毕云医院组织与政策作业(英文提交稿) by zhangyun

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									Flinders University in Association with
          Nankai University

MHA (Master of Hospital Administration)



             HSMT9016A:
Organization and Policy for Hospitals




        Name of Student: Bi Yun
             ID No: 2029720

             Date: July,13, 2005
Topic issue: Describe how you would            reorganize        the China Health

System.



Topic: Analyses the Chinese Health System present condition
and reorganize the China Health System by myself


Preface:

     The health system is an important system that a nation uses to guarantee

the safety and health of its people’s life, to maintain national stability, and to

promote national economic and social development. As the natural person in

society, regardless you have high statue or low, regardless you are wealthy or

poor, you should face the process of the birth →disease→death which

nobody can avoid this in his whole life. Therefore, the health is human

being's basic need. As a result, a nation owning a health service system that

matches its own situation is very important.

     China is a developing country; the economy is still not quite flourishing.

According to the recent report of United Nations development and Plan office,

the personal GDP of 2004 of China is US$4580; the “Human Development
                                                        [1]
Index” (HDI) ranks the 94 in 177 nations of world             . Therefore, there are

many problems in Chinese health system. Through the study of "hospital

organization and policy" course and some research, on the basis of analyzing

our current health system, this paper creates some conception about Chinese

health system.

1. Current Chinese health system present condition

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1.1 City health system circumstance

1.1.1 The medical treatment organization constitution circumstance

     It is divided into the nonprofit medical treatment organization and the

profit medical treatment organization, which are two major types in the

Chinese medical treatment organization currently.

     Nonprofit medical treatment organization is for social public benefits

service. Nonprofit medical treatment organization run by the government

provides the basic medical treatment service and carries out other tasks set by

the government. Enjoy the financial subsidy provided by the government on

the same level, carry out the medical treatment service of the government

provision leading price, enjoy the special policy of homologous revenue from

tax; Carry out the national concerning public finance, accountancy's laws,

policy. In Chinese cities the great majority of hospitals belong to this kind of

hospital, similar to the public hospitals in Australia.

    Profit medical treatment organization income can be used for the

investors’ repayment. The government does not hold that type of medical

treatment organization. This medical treatment organization independently

determine certain medical treatment service items according to the market

need; the medical treatment service price is released; they are operated by

law to independent manage and to pay tax. Also, the prices are set according

to the finance, accounting system and relevant policies of the businesses that

are operating them. This medical treatment organization mainly is sponsored

by the nonpublic economic entity, the scale of which is generally not big,

currently this kind of medical organizations exist in more developed

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economic regions in China, in small cities in the forms of small clinics. This

organization is similar to private hospitals (the Private hospital) in Australia.

1.1.2 The ownership and the management of the medical treatment

organization

     The great majority of the nonprofit medical treatment organizations of

the country belong to the nation. The upper level administrative supervisors

are usually assigned by the government instead of publicly elected. which

often cause some leadership only look up to their superiors and paying less

attention to the development of the hospital. The important decisions in the

hospital are not made through the democratic decisions Even if there are

events such as "employees’ representatives’ conference” but the important

decisions are usually not made by the majority.

1.1.3 The nonprofit medical treatment organization personnel system

and the allotment system

     In the nonprofit medical treatment organization that the government

manages, there are differences between full-time workers, the temporary

workers, and the contract workers. Full-time officers and workers' hold "very

secure jobs", enjoy the relatively high wages, high subsidy, high welfare,

even if they do not work well, their remunerate does not change much; But

some temporary workers or the contract workers who do not have very secure

jobs will often work hard because of the fear to lose their rice bowls.

1.1.4 The medical treatment service that the residents of the city enjoy

     Since 1999, in the overwhelming majority cities of China, employees of

profitable enterprises and all employees of the organization, business units,

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and social groups have been enjoying the basic medical treatment insurance

continuously. To be concrete: Basic medical treatment premiums are paid by

the employee as well as the employer, the basic medical treatment insurance

fund is from a mutual fund contributed by the employee and the employer All

of personal basic medical treatment premium for payment of officers and

workers accounts go into personal accounts, the basic medical treatment

premium that employers pay rows into the plan as whole fund and personal

accounts respectively.

     The officers and workers who participate in the basic medical treatment

insurance must go to the nonprofit medical treatment organization that the all

levels of medical treatment insurance centers approve to seek medical advice.

If cured for the out-patient service, the officers and workers rows the card to

pay on personal account, and the exceeding part will be paid by the person

himself; For the patients who stay in the hospital they need to pay off all the

charged items first through their personal account, the overspend part will be

paid by the mutual fund and the personal account; the diagnosed chronic

disease sufferers can pay the related medical treatment expenses by using the

chronic disease card. Those who are covered by the medical plan will be free

from the rules and regulations in the above-mentioned                  medical

organizations.

     Medical treatment and medicine should be managed with separate

accounts.

     An exception of the above-mentioned policy applies to a special group,

who enjoy an advantageous special policy of full reimbursement.

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1.2 Countryside health system circumstance

     It’s a very huge dimensionality in the countryside of China. In which

area the economy is undeveloped. Especially the area where is far way from

city and the mountain area has a lot of poor population living. The majority

of Chinese farmers has no basic medical treatment insurance, or even has no

money to purchase business medical treatment insurance. Once they get

sick, they will not be treated if the illness is light.   Otherwise, they will

collect whole family’s money it’s still a little to carry on the most simple

diagnosis and treatments, or they have to give up the treatment and allowing

the disease develop. Only an extremely small number may be lucky rescued

from the social contribution.

     According to the record of the third-time national hygiene service

investigate recently, 50% of city’s residents and 80% populations of the

countryside have no medical treatment insurance. Many people are poverty

caused by disease. As a result, a large number of farmers in China cannot get

good health service, which is still a problem now [2].

1.3 The problem of the Chinese current health service system

(1) The blemish of the system limited positive development of the hospital.

(2) The medical treatment insurance system is not sound.

(3) The medical treatment condition has a huge difference between the cities

and the countryside, the poor people and the rich people, the flourishing area

and the undeveloped area, the employee and the retirees.

(4) The medical treatment prevention and control system construct not

enough perfect. A lot of people think much of treatment but ignore

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prevention.

(5) The nation’s budget of the health system not enough. Compared with the

flourishing nation, the margin is greatly huge.

2. My Chinese health system speculation in the ideal

     The Chinese health service system reform cannot go well without

taking into consideration of the basic state of the nation, namely "the

population is huge, and the resources are few". Under this premise, I have a

brave thought about the future of the Chinese medical treatment system.

2.1City health system speculation
2.1.1 To reform the management system and the decision-making process

of the nonprofit medical treatment organization; any job is based on

competition, not assigned by the government.

     In nonprofit medical treatment organization for the hospital director's

ordination, better cancel the higher-up appointed way. Oppositely, to adopt

other ways that are election, recommendation, and the employee's

representative vote. The winner of the candidates has to be requited

examination and approval and to keep on record by the higher-up

administrative department. The director who is elected with that way can be

competent for the construction and developments of the hospital. The medical

treatment organization should execute <<the system of the employee

representative's conference decision-making>>. Any important decision that

belongs to the organization, for example, the personnel appointment and

dismiss; the decision of important events, and the important equipments

buying etc., should be submitted to the conference to decide and to pass. Let

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the decision-making power actually stay in the employee’s hand.

    Certainly, the implement of that way may cause the objection and

boycott from current directors, but the reform can bring new life and vitality

to the hospital run by the government.

2.1.2 Reform the human resource system and the allotment system, and

Practice the whole member employment system and the system of

different job different payment.

    We have to change the current human resource system that differentiates

the formal employee and the contract employee. Any position should be

established according to the need. Everyone has to compete to get the

position. And the income depends on the position. It can activate the

personnel reasonable fluxion. Practice the high pay system to the important

management professionals and the technique professionals, and give them

high subsidy and special subsidy...etc. To draw on the domestic and

international talented people. Raise the welfare and income to the employee

of hospital and making them get the homologous pay they deserve.

2.1.3 Enhance the system of category management; enhance the

construction of the profit medical treatment organization.

     Continue to use the different management method to manage the profit

and the nonprofit medical treatment organization. For the rich people can

have the high-quality medical treatment service, the government should

encourage domestic and foreign investors to invest in profit medical

treatment field in China. Presently, in China, most profit medical treatment

organizations are small-scale and don’t have high quality of the medical

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treatment, the government should strengthen to supervise and manage this

kind of medical treatment organization. The Chinese government has to

encourage Chinese and foreign investors to invest in large and

comprehensive profit medical treatment organizations.

2.1.4 Let all city residents have the basic medical treatment insurance

service.

    Some of the residents don’t have the medical treatment insurance. Most

of them are the employee of the government-owned enterprises which are

running badly, and some of them are the employee of the small businesses,

and some of them are unemployed etc. I think that all employers should be

responsible for their employees’ insurance whether the employers are

performing well or badly financially. For the state-owned enterprises, which

are performing badly, the government should encourage other enterprises to

purchase or merge them so that the employee could obtain the basic medical

treatment insurance from their new employer. For the unemployed the

government can build a special medical treatment insurance policy, such as

personal pays 20%-30% of the amount and the government to solving the

basic medical treatment problem for them subsidizes the rest part.

2.1.5 Develop commercial medical treatment insurance; encourage the

rich people to buy commercial medical treatment insurance.

   At present, various kinds of commercial medical insurance plans offered

by insurance companies are gradually mature. To help reduce the financial

burden of the government, the government can give some benefits to

encourage the rich people to take part in the medical treatment insurance.

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Such as: anyone has to join the medical treatment if his/her income is over a

range.

2.1.6 Strengthen the construction of disease prevention and control

system; give more budgets to the disease prevention and control

organization.

   As early as in January 1997, the Chinese Communist Party Central

Government and the State Council put out a new policy of “the prevention is

primary"[3], but it has not been well implemented. The department of health

administration put the main energy and budget to the medical treatment units

mostly.   The break out of the SARS in 2003 caught people’s attention to the

importance of the disease prevention and control. In January 2005, the

Chinese health department released <<The opinions of the construction of the

disease prevention and controls system>>[4] which leads people to pay

attention to the disease prevention and control work. “The center of disease

prevention and control” has the full support of the government. All of the

salaries of the employee come from the government.

2.2 A conceit of the countryside medical treatment service system

     I think we have a few ways to change the health service system at

Chinese countryside presently.

2.2.1 Open a new countryside cooperation medical treatment system to

let the farmers have the basic medical treatment service.

   We can build up a new system of the medical treatment cooperation in the

village. The farmer contributes a small amount to the medical treatment fund

annually. The local governments also contribute small parts. The big parts of

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the fund are offered by the central government’s public finance. These three

parts constitute the village cooperation medical treatment fund together.

When a farmer contracts some illness, the expenses are covered by that fund.

2.2.2 Build up the medical treatment mutual aid fund; resolve the

problem of the farmers "the small illness mutual aid"

    Establish "the medical treatment mutual aid foundation" in the village;

mobilize the farmers to take part in actively. Adopt the members to pay some

money for the mutual aid annually. If a member is ill and needs to pay for the

medical or treatment’s fee this year, the amount of money would be paid by

rule and by the foundation; if a member doesn’t see a doctor this year, they

can’t get the money back, but it is subsidized to the others. Certainly, "the

medical treatment mutual aid foundation" only can used at some area where

is not very poor and the farmers have some basic knowledge of health.

2.2.3 Society relieving towards the very poverty crowd and the farmers

who have the seriousness disease.

     A Social Relief Foundation for the Extremely Poor and the Serious

Illnesses in the Rural Area can be established.   Encourage the rich people

and enterprises to donate. The government has to give the donator some kind

of encouragement and provide some help by the government policy.

    In a word, most farmers should have the same rights as the city’s

resident do. Under the economic environment of current China, we have to

step by step solve the medical treatment and hygiene problems in the

countryside.

3.Brief summary

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     In conclusion, I think although some problems still exist in the health

system in China, the core problem lies in the economy's weakness. At present,

the economy of the country is pushing forward at a quicker speed. I believe

that the Chinese health system will be moving toward perfection along with

the continuous development of the Chinese economy.



                                        Reference
[1]United Nations development plans the office to release.http://finance.tom.com 2004.8.4;
http://www.ah.xinhuanet.com,2004.8.5
[2]HAN2 QI3 DE2.Speed the medical treatment health system reform step.
http://www.gmw.cn.2005.3.8.
[3]Win total central State Department concerning decision of hygiene reform and
development. People's newspaper, 1997-02-18(1).
[4]China people's health department. Ass for the disease prevention control some opinion
of the system construction. http//moh.gov.cn.




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